Facts and reflections on COVID-19 and anti-hypertensives drugs

Based on some publications that associate SARS-CoV-2 infection with the use of anti-hypertensivedrug groups such as angiotensin-converting-enzyme inhibitors (e.g. enalapril) or angiotensin IIreceptor blockers (e.g. losartan), many patients from South America, Central America or Spain,have stopped or intend to interrupt their treatments with these drugs. Hence, it may exist ominousconsequences due to this drop out. For this reason, it is necessary to quickly warn about thissituation and the risks associated with it.Fil: Marin, Gustavo Horacio. Universidad Nacional de La Plata; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Impact in the reduction of complications through a personalized follow-up strategy to ensure adherence to antihypertensive therapy

The lack in continuity of antihypertensive treatment is one of the major common causes of uncontrolled high blood pressure and increased of adverse effects and medical costs associated to this disease. The current study aimed to investigate the relationship between a personalized strategy that guarantees the adherence to antihypertensive treatment and complications related to hypertension. To do so, 586 patients hypertensive patients attending primary care institutions in La Plata Argentina, were randomly assigned either to an intervention group that had regular and periodically follow up contact to check treatment adherence or to control group. Both groups received free of charge antihypertensive medicines. The adherence was assessed with the adherence evaluation scale of Girerd. The presence of complications of hypertension disease (stroke, angina pectoris, myocardial infarct, transient ischemic attack, heart failure, kidney failure, retinopathy and death associated to this disease) were checked monthly. Among the 293 patients included in the intervention group study 98.63 % (289/293) were adherents while only 49.14% (144/293) of the control group had continuity in the therapy. Comparing complications events developed by patients belonging to Intervention vs Control group after 24 month of follow up were for overall events 19.79% vs 27.98% (p<0.001), for stoke 0.34/1.02%(pNS); angina pectoris 4.09/6.48% (p 0.004), 0.68/1.02 (pNS), TIA 0/0.34% (p NS), heart failure 4.77 /7.16% (p0.003), while hospitalization associate to primary hypertension disease was 16.04/30.3% (p<0.001)respectively. We can conclude that a personalized strategy to guarantee hypertension treatment adherence reduce the hospitalization and several complication associated to this disease.Fil: Marin, Gustavo Horacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; ArgentinaFil: Marin, Lupe. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; ArgentinaFil: Errecalde, Jorge Oscar. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; Argentin

Litigation for health technology accessibility: A tool for inequality? Reflections based on case study analysis

INTRODUCTION: The objective of this work is to analyze the characteristics of litigation for access to health’s goods and services in the Social Health Insurance (SHI) of Buenos Aires, Argentina. METHOD: Descriptive study with analytical stage, performed in SHI, analyzing litigation done by beneficiaries along 15-years period to obtain goods or service from health managers. Variables explored were: Reason for litigation, delay time in case resolution, final result of judicial sentence, judges, lawyers and intervening professionals, income level of beneficiaries who started the litigation. RESULT: 825 cases were analyzed during the study period according the method described. Demands increased 29.2 ±% per year. Medicines were the goods that most requested legal protection resources (32.5%). 51.9% of these litigations were due to medicines that have less than 24 months of registration by the National Regulatory Agency. The average delay for the final resolution of the procedure was 3.7 months. Judge's sentence was favorable to the beneficiaries in 97.4%. Although there are 27 judicial departments and many courts in each one; cases were concentrated in 47.4% only 2 very few courts. Litigation cases promoted by 112 out of the 15000 doctors that provides services to the SHI. In 73.7% of the cases, beneficiaries that litigated had a salary that exceed 4 times the minimum wage, and only 3.2% of them had low income. CONCLUSION: We show how legal appeals might be working as an inverse strategy to the one desired, transferring collective resources belonging to the entire population, towards an specific demand from the most economically wealthy sector of society. As long as access to health care litigation maintains its current individualistic pattern, it will hardly be able to develop its full potential to guarantee effective respect for the collective right to access to goods that beneficiary the whole community.Fil: Marin, Gustavo Horacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; ArgentinaFil: Marin, Lupe. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; Argentina. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas; ArgentinaFil: Aguero, Daniel Alberto. Universidad Nacional Arturo Jauretche; ArgentinaFil: Marin, Gina. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; ArgentinaFil: Pagnotta, Mariana. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; ArgentinaFil: Blanco, Luis. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; Argentin

Impact of mental illnesses treatment during the period 1950-2020: Analysis of a single mental institution, Buenos Aires, Argentina

Introduction: Mental health treatment has varied in the last century; however, the impact of these new therapeutical options is little-known. Objectives: To evaluate the impact of treatments for mental health diseases along the last decades. Methodology: retrospective, descriptive case-report study. Medical records of patients admitted to a Mental Health Institution in Buenos Aires, Argentina were evaluated over 7 decades. Variables analyzed were: age, sex, diagnosis, time of hospital stay, number of re-hospitalizations, drugs available per decade, cost of drug, cost of hospitalizations. Results: Hospitalization average lenght of stay was 6.33 months, with 3.18 readmissions per patient. In the 21st century it was detected a reduction in the length of hospitalization (4.66 months) and an increase in the number of hospitalizations (4.3 hospitalizations/patient). The number of drugs prescribed was 5.14 per patient (1.6 in the 1950s and 7.22 in the last decade). During 1950s, the most prescribed drugs were lithium and chlorpromazine, in the ’60s haloperidol; in the ‘70s benzodiazepines, haloperidol, and amitriptyline; in the ‘80s and ‘90s fluoxetine, sertraline, and BZD; from the 2000s paroxetine, risperidone, and pregabalin were added to the earlier drugs; and in the current decade new antipsychotics (olanzapine, ziprasidone, quetiapine or lurasidone), antiepileptics (lamotrigine) were included. Although diagnoses were maintained over time (schizophrenia, psychosis, bipolar disorder, dementia, depression) in the last decade, 27.7% of the hospitalized patients had dual pathology (addiction+other mental illness). Cost of drugs prescribed increased >9 times, while the cost of hospitalization increased >4 times in the last decade compared to the second half of the 20th century. Conclusion: Although new drugs to treat severe mental disorders reduced side effects associate to treatment, its efficacy did not improve neither the duration of the hospital stay nor in the number of re-hospitalizations along the past 70 years; while cost of new drugs increased 9 times.Fil: Marin, Gustavo Horacio. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Departamento de Articulación de Ciencias Básicas y Clínicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Giangreco, Lucia. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; ArgentinaFil: Marin, Lupe. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; Argentina. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas; ArgentinaFil: Valdez, Emilia. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; ArgentinaFil: Heig, Melina. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; ArgentinaFil: Kersich, Blas. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; ArgentinaFil: Marin, Gina. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; Argentin

The Role of Midwives in the First Level Of Health Care System

Since the beginning of human history the process of childbirth has been acknowledged as a life event involving bio-physiological as well as socio-cultured and psychological aspects. All cultures throughout history have had strategies to assist and accompany women during labor and birth, being the image of a midwife present in current and past societies. In Argentina, as in many countries of Latin America, the official discourses assign on midwifery a key role in primary health care. However, the absence of midwifes in the first level of health care leaves pregnancy, labor and postpartum controls under other professionals or under a hospital level care. In this paper we mention some successful experiences that were able to reduce maternal and child risk indicators only through the inclusion of midwives in the primary care health staff. The profile and attitude of midwife’s care during pregnancy, delivery and assistance of pregnant women during gestational period cannot be replaced by other professionals.Fil: Salsa Cortizo, Maria Victoria. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; ArgentinaFil: Marin, Gustavo Horacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; Argentin

History of indigenous policies as trace of erythrocyte antigen Dia in the current population of the American continent relationship between indigenous policies and blood phenotypes

Objective: The study aim to establish a debate on the different policies implemented at indigenous population in the American continent and their relationship with the presence of DiegoA antigen (AgDia) in blood phenotype of inhabitants of Buenos Aires,Argentina. Methods: It is a descriptive study with qualitative/quantitative approach. A comprehensive search of medical/social databases, using MeSH words. Limits were applied to include studies published after 1950 written in Portuguese, English and Spanish. Results: Dia antigen in the population of several American countries is relatively high, hence, it should be considered in screening panels perform to blood donors. Noteworthy, the exception of this panorama is Buenos Aires State, where the prevalence of this antigen is low. This data was correlated with indigenous policies carried out by former governments. The results showed in population living in regions where Dia is high policy performed by the colonizers towards the indigenous peoples was domination+integration+miscegenation. In Buenos Aires, however, that policy was annihilation of the natives which could explain the low presence of the antigen in the current population. Conclusion: The presence of Ag-Dia in the population of Buenos Aires is low compared to other Latin-American regions. The presence of Ag-Dia in Buenos Aires population is low compared to other regions of Latin-America. The reason could be explained by the distinctive indigenous policy performed in this area. It might be possible then to predict the prevalence Dia in the current population, taking into account the history of indigenous policy in colonization of American continent.Fil: Azzaro, Sebastiana. Provincia de Buenos Aires. Ministerio de Salud; ArgentinaFil: Marin, Gustavo Horacio. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Clapsos, Rosana. Provincia de Buenos Aires. Ministerio de Salud; ArgentinaFil: Marin, Lupe. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; ArgentinaFil: Margineda, Silvia. Provincia de Buenos Aires. Ministerio de Salud; ArgentinaFil: Cillero, Facundo. Provincia de Buenos Aires. Ministerio de Salud; Argentin

Erythropoietin treatment in chronic renal failure anaemia-biosimilar option in the rational use of medicine process in order to reduced public health economic burden

Biopharmaceuticals innovation molecules have changed the course of a large number of chronic diseases. Many of these molecules became Gold Standards in oncology, rheumatology and other illness. However, their cost makes these drugs unattainable for most patients, and often put the health systems’ budgets at risk. This study takes the anaemia due to Chronic Renal Failure disease (CRFD) as an example to a rational selection of treatment with erythropoietin (EPO) and compares the trade brand mark of this drug with biosimilars option. Prescriptions of EPO in 394 patients with CRFD were submitted to a protocol of rational selection based in efficacy/risk ratio demonstration. This protocol was able to reduce that initial number to 91 cases that could really benefited with EPO treatment. These patients were included in a cohort study that compared EPO trade mark with biosimilars option. The experience demonstrated equal clinical outcomes in both groups but a reduction to half the original cost when biosimilars were dispensed. Biosimilars demonstrated to be a cheap and safe option to increase medicine access for anaemia associated to CRFD.Fil: Marin, Gustavo Horacio. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Departamento de Articulación de Ciencias Básicas y Clínicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Marin, Lupe. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Departamento de Articulación de Ciencias Básicas y Clínicas; Argentina. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas; ArgentinaFil: Haag, Griselda Octavia. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Departamento de Articulación de Ciencias Básicas y Clínicas; ArgentinaFil: Risso, Paula. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Departamento de Articulación de Ciencias Básicas y Clínicas; ArgentinaFil: Errecalde, Jorge Oscar. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Departamento de Articulación de Ciencias Básicas y Clínicas; Argentin

Un "seño" jardinero: Una presencia disruptiva en la formación docente de nivel inicial en Bariloche

La Formación docente en el Nivel Inicial argentino históricamente estuvo marcada por la presencia de estudiantes mujeres. Esta situación se encuentra fuertemente vinculada a la extensión de mandatos sociales hacia este colectivo, en muchas ocasiones con una acrítica y poco reflexiva asunción de los mismos. En este contexto, la anomalía de una presencia masculina entre las estudiantes de un Profesorado con más de 20 años de trayectoria en la ciudad de Bariloche-Patagonia, pone en juego una diversidad de sentidos, discursos, prácticas y saberes que permiten visibilizar cómo la institución Nivel Inicial ha sedimentado supuestos que dificultan la posibilidad de concretar otros modos de ser docente, al mismo tiempo que ha generado estrategias que podemos identificar como expulsivas. De esta forma, la biografía académica del primer varón en graduarse en el Profesorado, nos sumerge en un recorrido de situaciones y experiencias que evidencian las dificultades que implica su condición de varón.Historically, teacher training at the Argentine Kindergarten was marked by the presence of female students. This situation is strongly linked to the extension of social mandates to this group, often with an uncritical and little reflective assumption of them. In this context, the anomaly of a male presence among students of a faculty with more than 20 years of experience in the city of Bariloche-Patagonia, brings into play a diversity of meanings, discourses, practices and knowledge that make it possible to visualize how the institution Kindergarten has settled assumptions that hinder the possibility of specifying other ways of being a teacher, at the same time that has generated strategies that we can identify as expulsion. In this way, the academic biography of the first male to graduate in the Faculty, immerses us in a journey of situations and experiences that show the difficulties involved in his male condition.Fil: Marin, Gustavo Ariel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Diversidad Cultural y Procesos de Cambio. Universidad Nacional de Río Negro. Instituto de Investigaciones en Diversidad Cultural y Procesos de Cambio; Argentin

The training of Physical Education teachers in North Patagonia: Mountaineering in an intercultural key

Este artículo focaliza en la disputa de sentidos y significados inherentes a la práctica y apropiación de actividades de montaña en la ciudad de Bariloche, a partir de la implementación de un Profesorado de Educación Física. Mediante un enfoque etnográfico, analizo desde “adentro” los modos en que las relaciones de poder y el mandato constitucional de interculturalidad se juegan en este proceso de configuración de conocimientos, subjetividades e identidades en una región con población y estudiantado mapuche. La hipótesis infiere que la formación de profesores está tan fuertemente marcada por sentidos hegemónicos, disputas y tensiones del propio campo que, aun enmarcándose en nociones de interculturalidad, reproduce las experiencias, discursos y saberes de una parte de la población, silenciando e invisibilizando los conocimientos de las culturas y poblaciones subalternas involucradas, tal como la población mapuche. Cuestiono mi hipótesis analizando los procesos efectivos de construcción/transmisión de conocimientos sobre actividades de montañismo dentro del Profesorado. También, reconstruyo los sentidos y significados que operan en la configuración de subjetividades en relación con las prácticas, discursos y saberes propios sobre el entorno desde la perspectiva mapuche para examinar las facetas de interculturalidad que la formación docente en ese campo silencia o contradice.This article focuses on the dispute of social senses and meanings inherent to the practice and appropriation of mountain activities in the city of Bariloche, from the implementation of a Physical Education Teacher. Through an ethnographic approach, I analyze from “inside” the ways in which power relationships and the constitutional mandate of interculturality are played in this process of configuration of knowledge, subjectivities and identities in a region with Mapuche population and students. The hypothesis infers that the training of teachers is so strongly marked by hegemonic senses, disputes, and tensions of the field itself that even framed in notions of interculturality it reproduces the experiences, discourses, and knowledge of a part of the population, silencing and invisibilizing the knowledge of the cultures and subaltern populations involved, such as the Mapuche population. I question my hypothesis analyzing the effective processes of construction/transmission of knowledge about mountaineering activities within the Teaching Staff. Also, I reconstruct the meanings and meanings that operate in the configuration of their subjectivities in relation to practices, discourses, and knowledge about the environment from the Mapuche perspective to examine the facets of interculturality that teacher training in this field silences or contradictsFil: Marin, Gustavo Ariel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Diversidad Cultural y Procesos de Cambio. Universidad Nacional de Río Negro. Instituto de Investigaciones en Diversidad Cultural y Procesos de Cambio; Argentin